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ch 31 the child with endocrine dysfunction Flashcards

1
Q

type of hormone: create the effect near the point of secretion

A

local hormone

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2
Q

type of hormone: released into the bloodstream
where they are carried to responsive tissues

A

general hormone

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3
Q

what 2 regulatory systems maintain homeostasis

A

endocrine system
autonomic nervous system (sympathetic and parasympathetic)

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4
Q

when does hormonal control of bodily functions regulate for children

A

12-18 months old

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5
Q

what hormone is deficient in hypopituitarism

A

growth hormone

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6
Q

how is diagnosis of hypopituitarism made

A

-plasma growth hormone levels
-hand xrays

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7
Q

Tx hypopituitarism

A

-biosynthetic growth hormone injections
-thyroid extract
-cortisone
-testosterone/estrogen/progesterone

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8
Q

what is the best time of day to give biosynthetic growth hormone injection

A

before bed

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9
Q

Rare neurodegenerative
condition reported in some
patients after receiving
human GH from cadavers

A

Creutzfeldt-Jakob Disease (CJD)
“human mad cow disease”

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10
Q

what disorders can hyperpituitarism result in

A

-acromegaly
-cushings disease
-galactorrhea

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11
Q

S+S acromegaly

A

-excess growth hormone, overgrowth of long bones
-increased muscle
-typical facial features

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12
Q

how is diagnosis of acromegaly made

A

-radiologic studies
-endocrine studies

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13
Q

Tx hyperpituitarism

A

-surgery to remove tumor
-radiation/radioactive implants
-hormone replacement therapy

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14
Q

what ages do precocious puberty occur in girls? boys?

A

girls: before 8 yo
boys: before 9 yo

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15
Q

3 types precocious puberty

A

-central
-peripheral
-incomplete

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16
Q

potential causes of precocious puberty

A

-disorder of gonads
-disorder of adrenal glands
-disorder of hypothalmic-pituitary-gonadal axis

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17
Q

med for Tx precocious puberty
when is it discontinued

A

lupron: slows prepubertal rates
stop med at normal puberty age

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18
Q

primary causes of diabetes insipidus (DI) ? secondary causes?

A

primary: hyposecretion of ADH
secondary: trauma, tumor, CNS infection, aneurysm

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19
Q

S+S diabetes insipidus in children? infants?

A

children:
-polyuria
-polydipsia (thirst)
-first sign often enuresis (bedwetting)
-dehydration
-high H&H
-high serum osmolarity

infants:
-irritability relieved by water (not milk)

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20
Q

meds for Tx of DI

A

-daily hormone replacement of vasopressin
-DDAVP (oral/nasal/IM/SQ)

*treatment for life

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21
Q

nursing interventions for DI

A

-accurate I&Os
-observe for signs of fluid overload
-seizure precautions
-DDAVP 2x/day

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22
Q

Produced by
hypersecretion of the
posterior pituitary
(increased ADH)

A

syndrome of inappropriate antidiuretic hormone (SIADH)

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23
Q

S+S SIADH

A

-fluid retention (water intoxication, overhydrated)
-anorexia
-N/V
-weight gain
-hyponatremia
-low serum osmolarity
-irritability
-personality changes

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24
Q

risk with DI

A

hypovolemic shock

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25
risk with SIADH
seizures
26
common S+S between DI and SIADH
excessive thirst
27
Tx SIADH
hypertonic saline fluid restriction
28
causes juvenile hypothyroidism
-congenital -acquired (after thyroidectomy or radiation)
29
S+S hypothyroidism
-slowed growth -excessive weight gain -constipation -sleepiness -delayed puberty -dry skin, sparse hair, periorbital edema
30
Tx hypothyroidism
-thyroid hormone replacement -prompt Tx needed for brain growth in infant
31
causes hyperthyroidism
-congenital (usually from maternal use antithyroid drugs during pregnancy) -acquired (neoplasm, inflammatory disease, dietary deficiency, increased secretion thyrotropic hormone)
32
important consideration for infant born with hyperthyroidism (goiter)
-precautions for emergency ventilation -hyperextension of neck helps with breathing
33
most common cause thyroid disease in children/teens
lymphocytic thyroiditis
34
S+S lymphocytic thyroiditis
-lymphocytic infiltration of thyroid gland -inflammation -hyperplasia (goiter) -usually euthyroid but with S+S of hypothyroidism
35
Tx lymphocytic thyroiditis
-may resolve spontaneously within 1-2 yrs -oral thyroid hormone helps decrease goiter -surgery is contraindicated
36
S+S hyperthyroidism (graves disease)
-exopthalmos -excessive motor irritability, tremors, insomnia, short attentions pan -GI hyperactivity (diarrhea) -rapid bounding pulse -dyspnea (even with light exertion) -heat intolerance (skin is warm and flushed)
37
Dx of graves disease
-increased T3 and T4 -decreased TSH
38
Tx graves disease
-antithyroid drugs (PTU and methimazole) -subtotal thyroidectomy -ablation with radioiodine
39
what things can cause thryotoxicosis "thyroid storm"
-infection -surgery -discontinuation of antithyroid therapy
40
Tx thyrotoxicosis
-antithyroid drugs -propranolol
41
what can you not eat when you take thyroid replacement meds
no dairy within 1-2 hrs of taking med
42
how does parathyroid hormone maintain serum calcium
-bone breakdown to release calcium and phosphate -helps kidneys absorb calcium and excrete phosphate -promote calcium absorption in GI tract
43
2 types hypoparathyroidism
-autoimmune hypoparathyroidism -pseudohypoparathyroidism
44
type of hypoparathyroidism: deficient production of parathyroid hormone
autoimmune hypoparathyroidism
45
type of hypoparathyroidism: production of parathyroid hormone is increased but organs are unresponsive to it
pseudohypoparathyroidism
46
facial muscle spasm elicited by tapping facial nerve in region of parotid gland
chvostek sign
47
carpal spasm elicited by pressure applied to upper arm
trousseau sign
48
carpopedal spasm (sharp flexion wrist and ankle joints), muscle twitching, cramps, seizures, stridor
tetany
49
earliest indication hypoparathyroidism
*anxiety and mental depression then paresthesia and heightened neuromuscular irritability
50
S+S hypoparathyroidism
-dry scaly skin with eruptions -brittle hair and nails -tetany -paresthesia -tingling -laryngeal stridor -headache -seizures -depression, confusion, memory loss -positive chvostek and trousseau signs
51
primary and secondary causes of hyperparathyroidism
primary: adenoma of gland (catecholamine secreting tumor) secondary: chronic renal disease, congenital abnormalities of urinary tract
52
Tx hyperparathyroidism
-surgical removal -or treat underlying cause -address hypercalcemia
53
three groups of secretions from adrenal cortex
-glucocorticoids (cortisol) -mineralcorticoids (aldosterone) -sex steroids (androgens, estrogens, progestins)
54
what does the adrenal medulla secrete
catecholamines: epinephrine and norepinephrine
55
causes acute adrenocortical insufficiency "adrenal crisis"
-hemorrhage into gland after trauma -sudden severe infections -abrupt withdrawal supplemental cortisone -failure to increase cortisone during times of stress
56
what is chronic adrenocortical insufficiency called (not enough cortisol)
addisons disease
57
possible causes cushings syndrome (too much cortison)
-excessive/prolonged steroid therapy -excess ACTH production from pituitary -hypersecretion glucocorticoids from adrenal -extrapituitary neoplasm -inappropriate adrenal response to secretion of polypeptide (food dependent)
58
S+S cushings disease
-excessive hair growth -moon face -weight gain -truncal obesity with red striae -poor wound healing -ecchymosis
59
how is Dx of cushings disease made
-blood test: excess cortisol levels -xray -fasting blood glucose -serum electrolytes -24 hour urine
60
Tx cushings disease
-surgery -replacement of growth hormone, ADH, thyroid hormone, gonadotropins, steroids
61
A family of disorders caused by decreased enzyme activity required for cortisol production in the adrenal cortex; overproduction of adrenal androgens
congenital adrenal hyperplasia (CAH)
62
S+S congenital adrenal hyperplasia (CAH)
-male: precocious puberty -female: born with varying degrees of ambiguous genitalia (enlarged clitoris, fused labia, intact internal sex organs)
63
what juices should be given with calcium replacement med to help it be absorbed better
cranberry juice apple juice
64
Dx CAH
-ultrasound of pelvic organs -chromosome typing -newborn screening measurement of cortisol precursor
65
Tx CAH
-assign sex according to gene phenotype -cortisone to suppress oversecretion ACTH -reconstructive surgery prn -teach parents to watch for dehydration and salt-losing crises
66
S+S hyperaldosteronism
-HTN -hypokalemia -polyuria
67
Tx hyperaldosteronism
-replacement potassium -spironolactone
68
Adrenal tumor that secretes catecholamines
pheochromocytoma
69
Tx pheochromocytoma
-*do not palpate (releases more catecholamines) -surgical removal of tumor -maybe bilateral adrenalectomy, lifelong glucocorticoid and mineralcorticoid replacement
70
3 types diabetes mellitus (DM)
-type 1 DM -type 2 DM -maturity-onset diabetes of the young (MODY)
71
type of diabetes: Characterized by destruction of beta cells, usually leading to absolute insulin deficiency
T1 DM
72
what children are at increased risk for T2DM
-native american -hispanic -african american
73
cause T2DM
insulin resistance
74
type of diabetes: Transmitted as autosomal dominant disorder with formation of structurally abnormal insulin with decreased biologic activity
maturity-onset diabetes of the young (MODY)
75
who is more likely to develop MODY
-obese teens -<25 yo
76
Tx MODY
-oral hypoglycemic meds -diet modification
77
Tx T2DM
-insulin injections -diet modification
78
Hyperventilation characteristic of metabolic acidosis resulting from the respiratory system’s attempt to eliminate excess CO2 by increased depth and rate; seen in ketoacidosis
kussmaul respirations
79
what can cause diabetic ketoacidosis (DKA)
-dehydration -electrolyte imbalance -acidosis -coma
80
S+S ketoacidosis
-ketones in urine -ketones in breath (fruity smell) -kussmaul respirations (hyperventilation)
81
when would you do urine testing for ketones for T1DM
-q3h during illness -glucose >240 if not sick
82
management T1DM
-insulin therapy -glucose between 80-120 -measurement A1C
83
longterm complications DM
-microvascular: nephropathy, retinopathy -macrovascular: neuropathy
84
nursing consideration when running insulin through IV
*run 50-100 mL out for priming it takes 50-100 mL for tubing to be saturated and not have insulin stick to it
85
what fluids are given for DKA
normal saline (no dextrose) bolus = 20 mL/kg in <20 mins IV drip: 0.1 U/kg/hr normal insulin
86
peak + duration regular insulin (rapid acting)
30-90 mins (duration 5 hrs)
87
peak + duration short acting insulin
peak 2-4 hrs duration 4-8 hrs
88
peak + duration intermediate acting insulin
peak 4-14 hr duration 20 hrs
89
peak + duration long acting insulin (lantus)
no peak lasts 24 hrs
90
how do you draw up multiple types of insulin in one syringe
clear to cloudy

peds (28 decks)

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